In 1973, The National Highway Safety Traffic Administration included manpower first on its list of the 15 essential elements of a modern EMS system. If we made this same list today, workforce would remain at the top because it’s the linchpin for the three key elements of health-care reform—access, cost and quality.

We need to start thinking about ensuring the EMS workforce will continue to be of adequate size to meet future demands. How to do this is complex because many factors affect the supply of EMTs and paramedics. It all begins with an adequate supply of qualified individuals, a focus on innovative continuous education and strong leadership.

Staffing to Reform
The expectation is that after reform is fully implemented and an additional 32 million people are insured, use of our health-care system will increase. For your system to succeed under reform, you may therefore need to adjust your staffing to handle the increased workload.

Many of these newly insured Americans won’t have a primary care provider, so they’ll continue to use EMS and emergency departments as the front door to the health-care system. Additionally, it’s expected that those who remain un- or under-insured will increasingly use safety net systems, such as EMS, to gain access to health care. This increase in patient volume will be compounded by an aging population that will require more care and services.

Era of CE
I often share insights from the late thought-leader George Autry, who dedicated an entire career to studying what made communities progress and living standards improve. Time and time again, his studies concluded that education brings change to any environment. If you have limited access to education or low educational standards, nothing gets better. This finding is as true for communities, regions and states as it is for health care.

James O. Page, the legendary EMS leader, also recognized and frequently noted that education is a cornerstone of any successful EMS system. And with health-care reform, it’s expected that the education bar will raise higher as more procedures and specialized care are shifted to the field.

The era of continuous education (CE) has officially arrived, and there’s no such thing as finishing school for an EMT. Grade school, college, technical education and continuous learning are all phases of our educational lives. In health care, CE should be a core expectation, and providers shouldn’t view ongoing education as an extra duty or optional depending on the desired career track.

Educational Innovations
Reform, will mean an increased demand for efficiency, measurable quality and a more highly skilled workforce focused on lifetime learning. Innovations in education, such as medical simulation, will enable the EMS workforce to learn not solely by reading—although reading is very important—but by doing and practicing.

Simulation presents an important new interface tool that’s real time and allows you to repeat activities, thus honing skills and alleviating the stress that comes with inexperience.

Simulation also allows for a new level of analysis, enabling the identification of potential problem areas. For example, WakeMed Center for Innovative Learning Manager Amar Patel, EMT-P, a 2009 EMS 10 Innovator in EMS honorary mention, has studied videos of IV starts on simulators, broken down the 61 processes to start an IV and identified that the biggest chance for infection occurs between steps 15 and 16—site cleaning and IV insertion.

Medical simulation has long been used in the health-care field for physician training. It’s only more recently that EMS has had access to simulation training and that the simulation training is becoming more specific to the tasks and functions of EMS.

Leading to the Future
A well-trained, engaged supply of qualified EMS workers was important before reform, and it’s even more important now. Knowing who will handle the increased workload stimulated by health-care reform and understanding what the employee of tomorrow will look like and need is critical to being successful in a reform environment.

Equally as important to health-care reform is an insightful and effective leader to help the workforce navigate, accept and understand the changes coming under health-care reform. Good leaders will be out front making changes and watching for signals to stay one step ahead. They’ll ensure their workforce is ready to take on the challenges of tomorrow, successfully create standards and diffuse innovations. Good leaders must understand the workforce and provide opportunities for continuous learning and growth.

Successful leadership is key, but leaders cannot succeed alone. They must have good people who believe in the organization’s mission and buy into the vision. And leaders must have the right people in the right place, set standards and expectations, and provide the tools for success. They also must orchestrate these elements in a way that accomplishes their organization’s goal to provide access to exceptional patient care at a reasonable cost. JEMS

William K. Atkinson, PhD, MPH, MPA, EMT-Pis the president and CEO of WakeMed Health & Hospitals and a JEMS editorial board member. He has devoted more than 30 years of his career to improving our nation’s emergency medical and prehospital care system.